Managing Dermatologic Delusional Disorders: A US Psychodermatology Perspective for Clinicians.

Area of Science:

• Psychiatry
• Dermatology
• Psychopharmacology

Background:

• Dermatologic delusional disorders (DI) involve delusions of infestation, previously considered untreatable.
• Antipsychotic medications, particularly pimozide and risperidone, have shown efficacy in treating DI.
• Patient denial of psychiatric involvement complicates management.

Purpose of the Study:

• To provide a psychodermatology perspective on managing dermatologic delusional disorders.
• To synthesize clinical experience and available evidence for practical management strategies.
• To highlight engagement, pharmacotherapy, safety, and research priorities.

Main Methods:

• Synthesis of single-center clinical experience from a US clinic.
• Review of existing evidence on managing dermatologic delusional disorders.
• Focus on pragmatic engagement and pharmacotherapy principles.

Main Results:

• Antipsychotic medications are effective for DI, despite initial skepticism.
• Diplomacy, empathy, and strategic engagement are crucial for patient management.
• Limited high-quality comparative data necessitates experience-based recommendations.

Conclusions:

• Successful management of DI requires a combination of pharmacotherapy and skillful patient interaction.
• Addressing patient denial and building rapport are essential for effective treatment.
• Further research is needed to establish evidence-based guidelines.